Please help.
Cigna Insurnace Novant Plan.
There was a genetic test i did not need, as someone in my family had already done the test.
The doctor told me the test would be covered so we should do it anyway.
I now have a bill for $1300 because the genetic test facility was out of network.
How do I dispute this?
Obviously already called my insruance and they gave me the sucks to suck speech.
Myriad genetic testing
Edit: thank you all for the helpful advice "you should have known better". I understand I should have called my insurance provider first, but I have a unique insurance plan because I work for a hospital system. I trusted his opinion more than I normally would have. Im just trying to figure out how I can work with this.
Doctor told me test i didnt need was covered $1300 bill
byu/tastyjams77 inInsurance
Posted by tastyjams77
20 Comments
I would send the bill the doc.
Have you gotten a bill yet? A lot of these genetic testing labs have a pseudo-scam where they bill insurance a huge amount but don’t actually try to collect from the patient if the claim is denied.
There’s not much to dispute though. Your doctor has no idea what insurance will cover and you shouldn’t listen to them about insurance.
Nothing your insurance can do here, it was your doctor who was wrong/lied to you. Call them and see if they will help with the bill, and if they wont, Id make sure to leave a review everywhere you can telling people what happened.
Unfortunately it’s somehow your responsibility to navigate the super complex healthcare jargon and insurance language to check if you have coverage for something. If you screw it up, then you are on the hook for $$$. That’s just how healthcare in America works.
Well, you could consider taking the doctor to small claims court. But, if it was a verbal conversation there’s no proof, and you won’t get anywhere. Leaving bad reviews is probably a really good idea. Then future patients will know to look out.
Don’t know about the bill, but a genetic test on a family member does not mean you have the gene being tested for or vice versa.
I’m not sure how your doctor would know whether or not it was covered by your insurance. That’s something that you should have verified with insurance before the test.
Despite what your doctor says, it’s up to you to verify that a test or procedure is covered.
I always speak with the verifications / billing department (or whatever it’s called at a specific office) to confirm that they check with my insurance company first. If I don’t get a satisfactory answer, I call the insurance company myself.
Let me guess BRCA gene? Its even better when they come back inconclusive and you still have to pay the bill. We won’t send to Myriad at my hospital. We will draw the test for the patient for a fee. Then we give it back to the patient so they can mail it to Myriad directly. High denial rate on that test.
Call the genetic testing facility. 99% they have a cash pay option of $200 or so
Beware my Doctor literally handed me a piece of paper Incase I wanted a cancer lung screening. I get a bill for $145 for him literally handing me a piece of paper . I never got the screening done . I had nothing wrong with my breathing he said if I wanted to because I had smoked in the past. Needless to say he is no longer my doctor
In the United States, you can never trust a medical provider to tell you what your out-of-pocket cost for anything is going to be.
They don’t do it on purpose, and it’s human nature that if someone asks you a question, you want to try to answer.
They have no idea what the insurance negotiated rate is.
They have no idea whether you’ve met your deductible.
They have no idea what your copay might be.
The fun thing is you can’t generally ask your insurance company and get an answer, either!
The American healthcare system is, to use a technical term, “ultra-fucked.”
I have diverticulitis. It flairs up now and then. When it does, it is a 10 day course of antibiotics, the first 4 days I can’t eat. I’ve been living with this for about 20 years now. It flairs up every few years or every few months. Mostly years. All in all I’ve dealt with it over a dozen times.
First few after the first were simple enough. Go to the doc, tell him what’s going on. Get my meds and heal. Sometimes it was just a phone call and a run to the pharmacy.
About 5 years ago I got a new doctor. Now every time it flairs up, they want me to get an MRI first. An MRI cost me $250 on the copay. So now they want me to pay that every time. What is the effect? I try to ride it out. They told me the first time that they wanted to make sure it wasn’t cancer. The next time, they told me it wouldn’t detect cancer, it is to insure that I didn’t have a tare in my intestine. I already know that if I had a breach/ tare I would be running a fever. I was not. Over the past few years I’ve spent about $1500 on MRIs that show nothing.
Was the sample gathered by an in network Doctor, or did they send you out and the lab gathered the sample?
Was the lab part of the same clinical group as the covered Doctor?
In some cases you might be able to argue that you were sent to a captive facility that is part of a covered Doctor’s practice.
No guarantees though.
Some more details would help me know if https://www.hopkinsmedicine.org/patient-care/patients-visitors/billing-insurance/no-surprises-act applies.
Do not care what else thinks as far as “This is healthcare in America”. This isn’t right and we shouldn’t be putting up with this fucked up system. Healthcare is a right.
I did genetic counseling through a hospital.
They said the company would contact me in advance if my insurance would not pay in full.
They then sent me the test and the company sent me a bill a month or two later.
The company had an appeals process, which I filled out, indicating that I was told that it would be discussed with me in advance if there were any fees and I had not received any emails, texts, or phone calls regarding charges.
I was notified within a day or so that they were honoring my appeal and removing the charge.
About 5 years ago, my wife was having abdominal pain and her doctor did a breath test. As a result, she got antibiotics and got better. Our insurance said the test was experimental and refused to pay. The denial cited two papers, one was 15 years old and the other was 30 years old. I found numerous more recent papers, including a review with 20 authors on the breath test. After a year of writing letters and filing two appeals, the insurance paid in full to make me go away.
Normally you don’t have to pay genetic labs if it’s denied. Talk to them.
I once had a STI screening that I called my insurance hotline and asked if I could get this done at this one clinic and they said yes. Guess what happened nearly 7 months later! I got a bill from the clinic saying my insurance would not cover the screening because I did not see my provider first and get their okay to have a screening.
I was livid and of course I called insurance and they said sorry you have to pay because your particular plan says this jargon and the person on the phone did not know the details of your plan. Are you freaking kidding me? USA healthcare is legalized extortion.